Liposuction: Benefits and Risks

The decision to have liposuction, technically known as liposuction, can have very different reasons. Aesthetic aspects are often decisive, but liposuction can also be useful for the treatment of diseases such as  lipoedema . But the decision for or against liposuction should be carefully considered, because the procedure also has disadvantages and risks. In the following we offer you a decision-making aid and inform you which advantages liposuction can have and what speaks against it, how liposuction works and how expensive the  operation  is.

What is liposuction?

In liposuction, fat cells are loosened from specific areas under the skin and surgically removed. They are sucked out with a cannula in the form of a mixture of fat cells and a previously injected solution. Liposuction is often a cosmetic operation, but the procedure can also be used for diseases.

Liposuction is possible on the stomach, legs, buttocks, hips or chin, among other things.

How does liposuction work?

In order to be able to have liposuction, the fatty tissue must first be prepared for the procedure. For this purpose, about half a liter to several liters of a mixture called  tumescent solution is  pumped into the affected body region. The mixture consists of an anesthetic and sterile, isotonic water, sodium bicarbonate and  cortisone .

Depending on the amount of turmescence solution, a local  anesthetic must also  be applied. General  anesthesia  is rarely used and is usually only necessary for very extensive liposuction.

After a waiting time of around 30 to 120 minutes – depending on the size of the area – the fat cells have soaked up the solution, separated and the conjunctival tissue is stabilized. Only then can the resulting mixture of tumescence solution and fat cells be  “sucked out” using special cannulas and gentle suction  . In order to insert the cannulas, small skin incisions are made in different parts of the body in advance. These are about half a centimeter in length.

Depending on how extensive the procedure is, the liposuction itself takes  between 20 minutes and two hours.  During the operation, the doctor measures the amount of fat cells extracted, which are collected in special containers. This ensures that the same amount of fat has been removed from different parts of the body and that there are no irregularities in appearance.

After the procedure, the skin incisions are stitched or taped.

What methods of liposuction are there?

In the meantime, two common surgical methods for liposuction have become established. In  vibration-assisted liposuction (VAL)  , the cannula used for liposuction vibrates to loosen extra fat cells. This method is also known as power assisted liposuction (PAL).

In  water-jet assisted liposuction (WAL)  , significantly smaller amounts of tumescent solution are used. As a result, the treated areas also swell less. The treating surgeon can therefore better assess the final result during the course of the operation. The duration of the operation is also shortened, since the small amount of solution also takes less time to distribute.

With the WAL, the cannula contains a second channel in addition to a channel for liposuction. Through this, water is sprayed into the subcutaneous fatty tissue with slight pressure. This loosens the fat cells and at the same time pushes the connective tissue, blood and lymphatic vessels and nerves aside and protects them from injury. However, compared to vibration-assisted liposuction, water jet-assisted liposuction causes  hematomas more frequently  and is considered to be more painful overall.

So both methods have advantages and disadvantages. In a consultation with the doctor treating you, these can be discussed and the appropriate method can be selected.

Less common methods are, for example,  laser lipolysis,  in which the fat cells are liquefied using a laser beam, and the  ultrasound method (UAL),  in which the fat cells are destroyed using an ultrasound probe and then suctioned off.

How much does liposuction cost?

The cost of liposuction varies depending on the extent and area where the fat is to be removed. As a rule, they are between  1,500 and 2,000 euros  per zone. In addition, there may be costs for consultations and follow-up treatment. The prices vary depending on the provider. In general, however, you should be suspicious if the prices are too low and check whether a reputable surgeon is really at work.

Since it is usually a purely aesthetic procedure, the costs are  usually not covered by health insurance  .  Liposuction is also not a recognized therapy in the case of  morbid obesity , which is why it is not covered by health insurance and the costs have to be borne by yourself.

In certain cases, however, health insurance will also pay for liposuction. This has been the case for stage 3 lipedema since December 2019. The assumption of the costs is that a medical diagnosis has been made and conservative therapy has been carried out for at least six months without alleviating the symptoms. In addition, liposuction is only performed if the  BMI  is less than 40. The regulation is initially limited until December 31, 2024.

What do you have to consider after liposuction?

After liposuction, you should observe the following tips and rules of conduct:

  1. Immediately after liposuction, i.e. still in the operating room, a so-called  compression garment  (for example a bodice) is pulled over the operated regions. This must be worn for about four to six weeks after the operation. This prevents the cavities created by liposuction from filling with blood, tissue fluid or any remaining dissolved fat. This could cause scars or  knots  . After a few days, the compression underwear can usually be removed, at least to take a  shower  . It is best to discuss the exact procedure with your doctor.
  2. After a minor liposuction,  no inpatient stay  in the hospital is necessary. In the case of a more extensive operation, an inpatient stay of one to two days is recommended.
  3. As with other operations,  general well-being  and circulation can be affected in the first few days after the operation. If you notice severe circulatory problems  with weakness,  nauseatachycardia  or  sweating within the first 24 hours after the procedure   , you should consult a doctor. Because these symptoms can indicate  unnoticed bleeding  .
  4. Sport  is only possible again two weeks after the procedure and should initially only be practiced with caution.

There  is usually no sick leave  after liposuction, as the doctor can only issue this for medically necessary interventions. Leave must therefore be submitted to the employer for the recovery phase. An exception here is liposuction for lipoedema: There is a medical reason for this, which is why sick leave is issued.

How long does swelling last and when is the result visible?

Liposuction can also lead to water retention. On the one hand, these are caused by residues of tumescence solution that cannot be completely removed and, on the other hand, by the fact that wound fluid is stored in the body. How long water retention persists depends entirely on the personal regeneration of the body. However, after about two to six weeks, severe swelling should have completely subsided. Ice packs can help get rid of swelling faster after liposuction.

After about three to four months, the first purely cosmetic check by the doctor takes place. By this time, the skin had already receded due to skin shrinkage and slight swelling had also subsided. However, it can take up to six months before the result of liposuction is visible in its final form.

It takes up to twelve months for liposuction to heal completely.

Reasons for liposuction

Liposuction is often performed to shed extra pounds. The surgical procedure offers the following advantages:

  • Fat deposits that have formed in undesirable areas can be removed in a targeted manner.
  • An experienced surgeon controls the distribution of the remaining fat cells during the procedure. In this way, a particularly beautiful and even result can be modeled.
  • Compared to losing weight naturally, liposuction achieves results quite quickly, although swelling can still appear months after the operation.
  • While  dieting  or a long-term change in diet combined with exercise requires discipline and is often associated with setbacks and frustration, liposuction provides a relatively safe result.
  • Once fat cells have formed, they become thinner when you lose weight, but their number cannot be reduced naturally. Only with liposuction are the fat cells actually removed from the affected area.

What are the risks of liposuction?

Liposuction is a surgical procedure that also involves risks. Liposuction can cause the following complications:

  • Bruising and bleeding
  • Wound healing disorders due to infections
  • Formation of blood clots and subsequent  thrombosis  or embolism
  • allergic reactions to  drugs
  • Sensitivity to touch or numbness lasting several weeks
  • Loss of tissue fluid or blood that needs to be replaced with IV fluids
  • Fat embolisms: Blood vessels are rarely blocked by fat droplets.

Death rate from liposuction

The mortality rate for liposuction is comparatively low. In a study by the Ruhr University Bochum, which took place between 1998 and 2002, around 2,200 questionnaires were evaluated. These were answered by intensive care departments, pathologies and forensic medicine institutes in Germany, Switzerland and Austria. 23 deaths were reported as a result of liposuction. This corresponds to a rate of around one percent for this period and these three countries.

According to an article in the journal Plastic and Reconstructive Surgery, the mortality rate after liposuction in the United States was one in 5,000 in 2000. That would correspond to 0.02 percent. The most common  cause of death  was a  pulmonary embolism .

It is difficult to give an exact indication of the current mortality rate from liposuction due to the lack of current figures. According to the Society for Aesthetic Surgery Germany e. V. (GÄCD), however, modern surgical methods help to minimize the risks of the past 20 years.

Reasons for serious complications are often poor hygiene, excessive amounts of tumescent solution, overdose of medication or poor monitoring after the operation.

Another reason may be that liposuction is performed on people who do not have the health requirements for such an operation (e.g. if they have previous illnesses such as  diabetes  or cardiovascular diseases, or are extremely  overweight , since this already puts a strain on the organism).

If you decide to have liposuction, it is therefore extremely important to choose a reputable and experienced specialist in plastic surgery. He will clarify with the person concerned whether liposuction is possible and in what form it will be carried out.

Other disadvantages of liposuction

In addition to possible complications during the operation and aftercare, liposuction can also have other disadvantages:

  • Liposuction alone does not have a long-term effect – if you do not change your lifestyle and do not exercise regularly and pay attention to a healthy and balanced diet, you will quickly regain the weight lost through the operation. Although there are fewer fat cells in the body as a result of liposuction, the remaining fat cells can still fill up with fat and expand again. This means there is a risk that the fat will simply move to other places.
  • Liposuction is not suitable for people who are very overweight. The amount of fat cells that can be removed during an operation is quite limited. In addition, during liposuction, the surgeon does not reach the so-called visceral fat, which is stored around the organs inside the abdomen and is therefore particularly harmful to health. The risk of complications also increases with body weight.
  • If the skin is not very elastic, it can happen that it does not recede sufficiently after liposuction. Excess skin flaps remain. Another operation is then necessary to tighten the skin in the appropriate places.
  • If scar tissue remains, this may also have to be removed in a further operation.
  • Like any operation, liposuction is associated with pain. These are often reminiscent of  sore muscles , but can also be felt as burning, stinging or itching. How long you have pain after liposuction varies greatly from person to person. In some cases, they can last for several months.

Special case lipoedema

Lipoedema is also known as the “saddlebag phenomenon”. Here, pathologically increased subcutaneous fatty tissue forms, for example on the arms, legs (often on the thighs), hips or buttocks, which leads to swelling and pain in the affected area.

Liposuction can help those affected in some cases. However, the operation is only recommended if the possibilities of conservative therapy, such as decongestion therapy, do not show any effect despite prolonged use. As already described, liposuction for lipoedema is only covered by health insurance in stage 3 of the disease and under certain conditions.

There are first indications that liposuction can stop the progression of lipoedema in the long term or at least alleviate its course. Extensive research work is still pending at the current time.

This is at least countered by the fact that the newly produced fat can be “stored” in other places in the future. This would contradict the long-term benefits of liposuction for lipoedema. There is also a risk that superficial lymphatic vessels will be destroyed during the course of the operation. This could result in a so-called  lymphedema , i.e. a storage of  lymph fluid .

Liposuction: yes or no?

Liposuction can be a quick, and therefore tempting, solution to get rid of a few extra pounds. Like any surgical procedure, however, it involves risks that you should be aware of before deciding for or against liposuction.

Eating a healthy diet and exercising regularly can be a good alternative to liposuction for small pockets of fat – a few habit changes can often help shed a few pounds. In our sections ” Lose weight easily ” and ” Fitness ” you will find many helpful tips to make losing weight easier.

If a change in diet and exercise alone no longer help with severe obesity, a stomach reduction may be the treatment of choice. Your general practitioner can advise you on this and, if necessary, refer you to a specialist. However, this is a major surgical procedure that, like liposuction, should be carefully considered.


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